Christopher Palmer, MD, FCCM
Washington University in Saint Louis School of Medicine
Saint Louis, MO
Disclosure information not submitted.
Beth Taylor, DCN, RD-AP,FCCM
Research Scientist
Barnes-Jewish Hospital
Maryville, Illinois
Disclosure information not submitted.
Bryan Lizza, MS, PharmD, BCCCP
PharmD, BCCCP
Barnes Jewish Hospital, United States
Disclosure information not submitted.
Kevin Betthauser, PharmD, BCCCP
PharmD, BCCCP
Barnes Jewish Hospital, United States
Disclosure information not submitted.
Heidi Tymkew, PT, DPT
Physical Therapist
Barnes-Jewish Hospital
St. Louis, Missouri, United States
Disclosure information not submitted.
Donna Prentice, PhD, RN, CNS, FCCM
Research Scientist
Barnes-Jewish Hospital
Saint Louis, Missouri, United States
Disclosure information not submitted.
Jamie Archer, MOT, OTR/L
Occupational Therapy
Barnes-Jewish Hospital, United States
Disclosure information not submitted.
Brittney Rufkahr, MSW
Social Worker
Barnes-Jewish Hospital, United States
Disclosure information not submitted.
Sarah Smith, PhD, MD
Physician
Washington University in St. Louis, Missouri, United States
Disclosure information not submitted.
Jessica Nelson, MD
Physician
Washington University in Saint Louis - School of Medicine
St. Louis, Missouri, United States
Disclosure information not submitted.
Patricia Nellis, OTD, OTR/L
Occupational Therapist
Washington University School of Occupational Therapy, United States
Disclosure information not submitted.
Elizabeth Wilson, BS
Research Coordinator
Washington University School of Medicine, United States
Disclosure information not submitted.
Brian Fuller, MD, MSCI,FCCM
Associate Professor of Anesthesiology and Emergency Medicine
Washington University/Barnes-Jewish Hospital
Saint Louis, MO
Disclosure information not submitted.
Title: Feasibility of a Multidisciplinary COVID-19 Virtual Post Intensive Care Syndrome Clinic (CoV-PICS)
Introduction: About 50-70% of ICU survivors suffer from Post Intensive Care Syndrome (PICS), in COVID-19 patients this may be higher due to prolonged disease severity, immobility, and isolation status. We developed the CoV-PICS clinic to assess the rising number of COVID-19 ICU survivors and test the feasibility of a telehealth clinic. A multi-professional group including an ICU physician, nurse, pharmacist, social worker, physical therapist, occupational therapist and dietitian participated in this study.
Methods: A prospective feasibility trial combined with retrospective chart review of 14 patients who were contacted for verbal consent once discharged to home. Patients completed online REDCap surveys prior to initial and 3-month virtual visits and at end of study. One-hour virtual visits were attended by all team members. Primary outcomes of the trial were determined using the Acceptability of Intervention (AIM), Intervention appropriateness (IAM), and Feasibility of intervention (FIM) measurement tools. The ICU Memory Tool, PROMIS 29 Profile, the MOCA-5 minute, and nutrition PG-SGA short form were used to trend mental health, functional, cognitive and nutritional impairments. In addition, the five time sit-to-stand, 2-minute step test and the Katz and Lawton tests were administered during each visit. Statistical analysis was performed for hypothesis generation given the small sample size.
Results: Patient AIM®, IAM® and FIM® responses were measured on a 5-point Likert scale (5=Completely agree) with group averages of 4.8, 4.8, and 4.9 respectively, indicating a high-level of acceptability, intervention appropriateness, and feasibility of the virtual CoV-PICS clinic. Half of the patients endorsed fatigue, feelings of panic, and intrusive memories. Patients demonstrated impairments in strength (93%), aerobic capacity (77%), independence with ADLs (86%), cognition (21%) and nutrition status (14%). Some improvements were noted at the 3-month visit.
Conclusions: This study demonstrated feasibility of a completely virtual and multi-professional clinic to assess COVID-19 ICU survivors, collect objective measures of PICS symptoms, and make treatment recommendations. Future studies to test effectiveness, applicability to all ICU survivors with PICS, and optimal telehealth clinic structure should be evaluated.